Endocrinology quiz

Endocrinology Quiz

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Question 1

Which of the following hormones are produced in the posterior pituitary gland?

A

Follicle Stimulating Hormone (FSH)

B

Growth Hormone (GH)

C

Adrenocorticotrophic Hormone (ACTH)

D

Thyroid Stimulating Hormone (TSH)

E

Oxytocin

F

Prolactin

G

Vasopressin (Anti-diuretic Hormone)

H

Luteinizing Hormone (LH)

Question 1 Explanation:

The posterior pituitary gland is only responsible for producing oxytocin and vasopressin.

Question 2

Which of the following are signs of acromegaly?

A

Decrease in tongue size (microglossia)

B

Visual field defects e.g. Bi-temporal Heminopia

C

Decrease in foot size

D

Crowded teeth

E

Enlargement of hands & fingers

F

Enlargement of tongue (macroglossia)

G

Increased jaw prominence

H

Oily skin

I

Enlargement of feet

J

Prominent supraorbital ridge

Question 2 Explanation:

The signs of acromegaly can be very obvious if the disease has been active for a significant amount of time. The changes in facial features and voice can be very disturbing for the patient as these are most often irreversible.

Question 3

Which of the following are clinical features of diabetic ketoacidosis?

A

Severe hyperglycaemia

B

Severe abdominal pain

C

Breath smells of pear drops

D

Coma

E

Severe hypokalaemia

F

Cerebral oedema

G

Severe hypoglycaemia

H

Kussmaul respiration (deep gasping breaths)

Question 4

"With metformin there is significant risk of hypoglycaemia"

A

True

B

False

Question 4 Explanation:

Metformin only increases insulin sensitivity and doesn't actually cause increased production or release of insulin. As a result it does not cause hypoglycaemia.

Question 5

Which of the following are commonly used in the treatment of diabetic ketoacidosis?

A

Atenolol

B

Activated charcoal

C

Potassium

D

Bicarbonate

E

Saline

F

Hydrocortison

G

Insulin

Question 5 Explanation:

The main aims of treatment are to reduce blood glucose & ketone levels using insulin whilst correcting dehydration & other electrolyte abnormalities

Question 6

What do Leydig cells produce?

A

Semen

B

Oestrogen

C

Testosterone

D

Androgen Binding Globulin

Question 7

Which of the following statements best describes the mechanism of action of Sulfonylureas such as Gliclazide?

A

The drug binds to PPAR’s (peroxisome proliferator-activated receptors) When PPAR’s are activated they cause transcription of a number of genes. These activated genes ultimately result in decreased insulin resistance

It works by binding to pancreatic beta cells & causing increased release of insulin

Question 8

Which of the following statements regarding cushing's syndrome is correct?

A

Women are more likely to develop cushing's syndrome

B

Men are more likely to develop cushing's syndrome

C

The incidence of cushing's syndrome is distributed equally between sexes

Question 9

Which of the following is not a symptom of cushings syndrome?

A

Easy bruising

B

Weight gain

C

Acne

D

Stretch marks

E

Increased pigmentation of skin

Question 9 Explanation:

Increased pigmentation of skin is not a symptom of cushings syndrome. Instead the symptom may indicate the presence of Addisons disease.

Question 10

Which of the following are not signs of cushings syndrome?

A

Buffalo hump

B

Moon face

C

Reduced visual fields

D

Central obestiy with relative sparing of limbs

E

Prominent supraorbital ridge

F

Proximal muscle weakness

Question 10 Explanation:

Both prominent supraorbital ridge and reduced visual fields are not signs of Cushing's Syndrome. Instead they are often seen in Acromegaly.

Question 11

Which of the following causes of cushing's syndrome does the phrase "cushing's disease" specifically refer too?

A

Iatrogenic

B

Pituitary adenoma

C

Ectopic ACTH production

D

Adrenal adenoma

Question 11 Explanation:

Cushing's disease refers specifically to cushing's syndrome occuring as a result of a pituitary adenoma.

Question 12

Which is a more sensitive measure of thyroid function?

A

Free T4

B

Free T3

C

Thyroid Stimulating Hormone (TSH)

Question 12 Explanation:

The adequate amount of free T3 & T4 in the blood varies significantly between patients. As a result the TSH value provides a sensitive indicator of whether a patients individual thyroid hormone levels are adequate for them.
If a patient has the correct amount of T3 & T4, their TSH value will be normal. However if the TSH is high or low it suggests that the level of thyroid hormones is not currently at the correct level for that patient. TSH is therefore an incredibly useful indicator when a patient has hypothyroidism and requires thyroxine. By monitoring the TSH value you can adjust the dose until TSH normalises, at which point you can be confident you are providing the patient with the correct amount of thyroid hormones.

Question 13

Which of the following hormones are produced in the anterior pituitary gland?

A

Follicle Stimulating Hormone (FSH)

B

Thyroid Stimulating Hormone (TSH)

C

Growth hormone (GH)

D

Luteinizing Hormone (LH)

E

Oxytocin

F

Adrenocorticotrophic hormone (ACTH)

G

Vasopressin (Anti-diuretic Hormone)

H

Prolactin

Question 13 Explanation:

The anterior pituitary is responsible for producing a large number of different hormones. Each of these hormones is produced by a subset of specialised cells within the anterior pituitary.

Question 14

Which of the following are symptoms of Type 1 Diabetes?

A

Decreased urination

B

Widespread erythematous rash

C

Polyurea

D

Weight loss

E

Decreased thirst

F

Polydipsia

Question 15

Which of the following are causes of Nephrogenic Diabetes Insipidus?

A

Lithium

B

Atenolol

C

Post obstructive uropathy

D

Sheehan's Syndrome

E

Mutations in the Vasopressin (ADH) receptor gene

F

Amyloidosis

G

Mutations in Vasopressin gene

Question 15 Explanation:

Nephrogenic Diabetes Insipidus involves the inability for the kidneys to respond appropriately the vasopressin (ADH) Anything which impairs the kidneys ability to respond to ADH has the potential to cause Neprogenic Diabetes Insipidus.

Which of the following is used as a first line therapy for neurogenic diabetes insipidus?

A

Desmopressin

B

Hydrocortisone

C

Somatostatin

D

Synacthen (synthetic ACTH)

Question 17 Explanation:

Desmopressin is a vasopressin analogue and therefore directly replaces the vasopressin normally produced by the posterior pituitary gland. It binds to v2 receptors on kidney allowing water to be reabsorbed. The drug can be given orally, intranasally, parenterally or bucally

Question 18

Which of the following statements best describes Diabetes Insipidus?

A

Diabetes Insipidus is a disease characterised by the passage of small volumes of concentrated urine

B

Diabetes Insipidus is a disease characterised by the passage of small volumes of dilute urine

C

Diabetes Insipidus is a disease characterised by the passage of large volumes of dilute urine

D

Diabetes Insipidus is a disease characterised by the passage of large volumes of concentrated urine

Question 18 Explanation:

Diabetes Insipidus is a disease characterised by the passage of large volumes (>3L/24hrs) of dilute urine (osmolality <300 mOsmol/Kg)

Question 19

Which of the following are correct regarding the effects of increased levels of growth hormone in acromegaly?

A

Increased levels of growth hormone stimulate increased production of Vasopressin (IGF1) from the adrenal glands

B

Increased levels of growth hormone stimulate increased production of Insulin Like Growth Factor 1 (IGF1) from the adrenal glands

C

Increased levels of growth hormone stimulate increased production of Vasopressin (IGF1) from the liver

D

Increased levels of growth hormone stimulate increased production of Insulin Like Growth Factor 1 (IGF1) from the liver

Question 19 Explanation:

The increased levels of growth hormone stimulate overproduction of IGF1 from the liver. IGF1 stimulates overgrowth of tissues and alters blood glucose & lipid metabolism. The actions of IGF1 therefore cause the symptoms seen in acromegaly.

Question 20

Which of the following are common symptoms of hypothyroidism?

A

Weight loss

B

Decreased tendon reflexes

C

Weight gain

D

Excessive hair growth

E

Dry skin

F

Oily skin

G

Hair loss

Question 21

Which of the following does the adrenal cortex produce?

A

Noradrenaline

B

Aldosterone

C

Adrenaline

D

Cortisol

Question 21 Explanation:

The adrenal cortex is responsible for the production of both cortisol and aldosterone. Adrenaline & Noradreniline are produced by the adrenal medulla

Question 22

Which of the following are common symptoms of hyperthyroidism?

A

Heat intolerance

B

Tremor

C

Weight gain

D

Weight loss

E

Urinary frequency

F

Diarrhoea

Question 22 Explanation:

Hyperthyroidism can present with a wide array of symptoms and these often differ considerably between patients. However symptoms such as weight loss, tremor, heat intolerance and diarrhoea are quite common.

Cushing's syndrome occurs as a result of an individual having abnormally high levels of cortisol. This can be due to a number of causes.

Question 24

Which of the following investigations is the gold standard for diagnosing acromegaly?

A

Growth Hormone Releasing Hormone Measurement

B

Growth Hormone measurement

C

Oral Glucose Tolerance Test + Growth Hormone measurement

D

Serum IGF1 Measurement

Question 24 Explanation:

Serum IGF1 measurement is useful to screen for acromegaly however is not ideal for diagnosis. Measuring Growth Hormone alone is also not very useful as it is secreted in a pulsatile matter therefore individuals levels vary greatly throughout the day. The oral glucose tolerance test combined with Growth Hormone measurement is the best as normally growth hormone should be inhibited by glucose intake however in acromegaly it will not be. Therefore presence of high levels of GH after glucose would confirm a diagnosis of acromegaly.

Question 25

What is the most common cause for the overproduction of growth hormone in acromegaly?

A

Pituitary adenoma

B

Hypothalamic lesion

C

Pituitary lesion

D

Hyperplasia of the pituitary stalk

Question 25 Explanation:

In around 99% of cases, acromegaly is caused by a pituitary adenoma, specifically overgrowth of the somatotrope cells which are responsible for growth hormone production. In very rare cases acromegaly can be caused by ectopic production of growth hormone by carcinoid tumours.

Question 26

Which of the following statements best describes the mechanism of action of Thiazolidinediones such as Rosiglitazone?

A

It works by binding to pancreatic beta cells & causing increased release of insulin

B

The drug binds to PPAR’s (peroxisome proliferator-activated receptors). When PPAR’s are activated they cause transcription of a number of genes. These activated genes ultimately result in decreased insulin resistance

Aldosterone causes reabsorption of sodium and water as well as causing excretion of potassium. This results an increase in blood volume and blood pressure.

Question 28

Which 1 of the following is the most useful investigation to screen for cushing's syndrome?

A

Dexamethasome suppression test

B

Oral Glucose Tolerance Test

C

Ultrasound of Adrenal Glands

D

MRI of pituitary fossa

E

ACTH Stimulation Test

Question 28 Explanation:

The Dexamethasome suppression test is the most useful in screening for Cushing's syndrome. In normal individuals levels of both ACTH & Cortisol should decrease after administration of Dexamethasome. If levels are not suppressed it suggests the diagnosis of Cushing's syndrome. MRI & Ultrasound can be useful as secondary tests to determine the underlying cause of the cushing's syndrome.

Question 29

Which of the following statements best describes the pathology of type 2 diabetes?

A

Occurs due to autoimmune destruction of the insulin producing pancreatic beta cells. The loss of insulin producing cells leads to insulin deficiency which in turn causes hyperglycaemia

B

A disorder of metabolism characterised by high levels of glucose in the blood as a result of insulin resistance and insulin deficiency

Question 30

What is the recommended definitive treatment for cushing's disease?

A

Adrenalectomy

B

Somatostatin Analogues

C

Trans-sphenoidal surgery

Question 30 Explanation:

Cushing's disase refers to cushings syndrome caused by a pituitary adenoma. As a result the definitive treatment involves the surgical removal of the pituitary adenoma. This is done using a trans-sphenoidal technique (up through nose)

Question 31

Which 1 of the following statements describes the underlying pathology of Grave's disease?

A

A benign tumour of the thyroid gland which produces excessive amounts of thyroid hormones

B

Inflammation of the thyroid gland due to infections or lymphocytic infiltration causes the stored thyroid hormones to all be released into the circulation leading to hyperthyroidism and usually thyrotoxicosis

C

Consumption of ground beef which has been contaminated with thyroid tissue. The thyroid tissue contains metabolically active thyroid hormones which causes the hyperthyroidism

Cushing's syndrome is very serious if left untreated with around a 50% mortality over 5 years. Death is usually due to cardiovascular complications such as heart failure or patients developing serious infections due to immunocompromise.

Question 35

Which of the following statements correctly describes the pathology of type 1 diabetes?

A

Disorder of metabolism characterised by high levels of glucose in the blood as a result of insulin resistance and insulin deficiency

B

Occurs due to autoimmune destruction of the insulin producing pancreatic beta cells. The loss of insulin producing cells leads to insulin deficiency which in turn causes hyperglycaemia.

Question 36

Which of the following hormones are produced by the adrenal cortex?

A

Epinephrine (Adrenaline)

B

Aldosterone

C

5-DHEA

D

Norepinephrine (Noradrenaline)

E

Cortisol

Question 36 Explanation:

The adrenal cortex produces cortisol, aldosterone and weak androgens such as 5-DHEA. Adrenaline and Noradrenaline are instead produced by the adrenal medulla.

Question 37

Which one of the following statements best defines dipsogenic diabetes insipidus?

A

Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary causing malfunction of the thirst mechanism

B

Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary stalk causing malfunction of the thirst mechanism

C

Dipsogenic diabetes insipidus is caused by a defect or damage to the hypothalamus causing malfunction of the thirst mechanism

D

Dipsogenic diabetes insipidus is caused by a defect or damage to the pituitary stalk causing malfunction of the hunger mechanism

Question 37 Explanation:

Dipsogenic diabetes insipidus is caused by a defect or damage to the hypothalamus causing malfunction of the thirst mechanism. As a result the individual is excessively thirsty regardless of their fluid status. The individual therefore consumes large volumes of fluid which suppresses secretion of vasopressin and increases urine output

Question 38

Which of the following are functions of cortisol?

A

Increase blood glucose levels

B

Stimulation of gluconeogenesis

C

Suppress immune function

D

Decrease blood glucose levels

E

Improve immune function

Question 38 Explanation:

Cortisol is produced in response to stress or low blood glucocorticoid levels. It's main functions are to increase blood glucose by promoting gluconeogenesis and suppress the immune system by silencing white blood cells.

Question 39

Which one of the following is acromegaly caused by?

A

Overproduction of Vasopressin (Anti-diuretic Hormone)

B

Overproduction of Gonadotrophin Releasing Hormone (GnRH)

C

Overproduction of Adrenocorticotrophic Hormone (ACTH)

D

Overproduction of Growth Hormone (GH)

Question 39 Explanation:

Acromegaly occurs as a result of overproduction of growth hormone. The increased levels of this hormone causes increased proliferation of a number of tissues which results in the characteristic features of acromegaly.

Question 40

Which 1 of the following is the most common cause of cushing's syndrome?

A

Pituitary adenoma

B

Glucocorticoid treatment

C

Adrenal adenoma

D

Ectopic ACTH production

Question 40 Explanation:

The most common cause of cushings syndrome is the long term use of glucocorticoid treatments (steroids). These treatments are commonly used to suppress inflammation in many diseases. If these treatments are used long term they can result in the development of cushing's syndrome. As a result most steroid treatments are only given for short durations.

Question 41

Which age group does acromegaly most commonly affect?

A

10-25 years

B

25-40 years

C

55-70 years

D

30-50 years

Question 41 Explanation:

Most who develop acromegaly are between 30-50 years old. Acromegaly would not develop in young children as their growth plates have not yet fused, so they would develop gigantism instead.

Question 42

Which of the following are causes of Addison's disease?

A

Pyelonephritis

B

Adrenoleukodystrophy

C

Malignancy

D

Tuberculosis

E

Autoimmune destruction

Question 43

In males which hormone stimulates Leydig cells to produce testosterone?

A

Follicle Stimulating Hormone (FSH)

B

Luteinizing Hormone (LH)

Question 44

Which 1 of the following is the most common source of ectopic ACTH production in ectopic cushing's syndrome?

A

Prostate cancer

B

Small cell lung cancer

C

Colon cancer

D

Large cell lung cancer

Question 44 Explanation:

Most commonly Small Cell Lung Cancer is responsible for ectopic production of ACTH.
The tumour for some unknown reason has genes switched on which enable it to produce ACTH. This stimulates the Adrenal Cortex to produce increased levels of Cortisol. High levels of Cortisol give rise to the symptoms of Cushing’s Syndrome

Question 45

Pseduo Cushing's Syndrome refers to a condition in which the patient has the signs and symptoms of cushing's however the cause is not related to the hypothalamic-pituitary-adrenal axis. Which 3 of the following are common causes of pseudo cushing's?

A

High serum aldosterone

B

Eating disorders

C

Alcoholism

D

Stress

E

High serum TSH

Question 46

Which of the following are symptoms of acromegaly?

A

Excessive sweating (Hyperhydrosis)

B

Headache

C

Visual changes (double vision, reduced vision, tunnel vision)

D

Deepening voice

E

Increased finger ring size

F

Vomiting

G

Abdominal distention

H

Diarrhoea

I

Tingling and weakness in hands

J

Widespread rash

Question 46 Explanation:

The symptoms of acromegaly can manifest in many different and seemingly unrelated ways. As a result patients often don't realise the link between there various symptoms and are therefore diagnosed much later on in the disease.

Question 47

Which 1 of the following hormones binds to the pituitary and stimulates the release of Luteinizing Hormone (LH) & Follicle Stimulating Hormone (FSH)?

A

Corticotrophic Releasing Hormone (CRH)

B

Adrenocorticotrophic Hormone (ACTH)

C

Gonadotrophin Releasing Hormone (GnRH)

Question 47 Explanation:

1. The hypothalamus secretes GnRH
2. GnRH travels down to the anterior pituitary gland
3. It binds to receptors on the pituitary gland
4. This causes release of LH & FSH

Question 48

The gene IDDM1 is thought to be strongly associated with the development of Type 1 Diabetes

A

False

B

True

Question 49

Which of the following are not symptoms of Diabetes Insipidus?

A

Production of highly concentrated urine (>300 mOsmol/Kg)

B

Nocturia

C

Minimal urination

D

Excessive urination

E

Production of dilute urine (<300 mOsmol/Kg)

F

Dehydration

G

Excessive thirst

Question 50

Which of the following are symptoms of addison's disease?

A

Hyperpigmentation

B

Postural hypotension

C

Moon face

D

Diplopia

E

Weight loss

F

Weight gain

G

Striae

H

Fatigue

Question 50 Explanation:

The lack of cortisol results in significant weight loss in the majority of patients (90%) Patients often feel very unwell and lethargic. Some patients also exhibit hyperpigmentation of their skin (often mistaken as a "healthy" tan) Some patients also experience postural hypotension due to the lack of aldosterone.

Question 51

Which 1 of the following is thought to be the cause of gestational diabetes insipidus?

A

Production of ACTH by the placenta

B

Production of vasopressinase by the foetus

C

Production of vasopressinase by the placenta

D

Production of vasopressin by the foetus

E

Production of vasopressin by the placenta

Question 51 Explanation:

Gestational diabetes insipidus only occurs during pregnancy. During pregnancy the placenta produces vasopressinase which breaks down vasopressin. Gestational diabetes insipidus is therefore thought to be caused by overproduction of vasopressinase by the placenta causing a lack of functional vasopressin.

Question 52

Which of the following statements describes Hashimoto's thyroiditis?

A

It is a destructive autoimmune disease that is especially common in middle aged women. The disease is caused by auto-reactive antibodies against thyroglobulin & other targets

B

Occurs as the result of iodine deficiency

C

Inflammation of the thyroid gland as the result of a virus
The disease is often preceded by a upper respiratory tract infection

Question 53

What is Addison's disease?

A

Addison's disease involves the underproduction of cortisol and aldosterone by the adrenal cortex

B

Addison's disease involves the underproduction of androgens by the adrenal medulla

C

Addison's disease involves the overproduction of cortisol and aldosterone by the adrenal cortex

D

Addison's disease involves the overproduction of androgens by the adrenal medulla

Question 54

In regard to the investigation of hyperthyroidism, which 1 of the following antibodies is specific to Grave's disease?

A

Thyroglobulin antibody (Tg Ab)

B

Thyroid Peroxidase antibody (TPO Ab)

C

TSH receptor antibodies

Question 54 Explanation:

TSH receptor antibodies are highly specific for Grave's disease as those antibodies are the driving force behind Grave's disease. The other 2 antibodies can be found in both Grave's & Hashimoto's.

Question 55

Which of the following statements best describes diabetic ketoacidosis?

A

It occurs due to a lack of insulin, which prevents the bodies cells from absorbing and utilising any glucose in the blood. As a result the body switches it’s metabolism to breakdown fat to produce energy. This process produces acidic ketones as a byproduct and these build up in the blood causing a metabolic acidosis.

B

It occurs due to a lack of insulin, which prevents the bodies cells from absorbing and utilising any glucose in the blood. As a result the body switches it’s metabolism to breakdown fat to produce energy. This process produces alkylotic ketones as a byproduct and these build up in the blood causing a metabolic alkalosis.

C

It occurs overproduction of insulin, which prevents the bodies cells from absorbing and utilising any glucose in the blood. As a result the body switches it’s metabolism to breakdown fat to produce energy. This process produces acidic ketones as a byproduct and these build up in the blood causing a metabolic acidosis.

D

It occurs due to a lack of insulin, which causes the bodies cells to absorb & utilise an abnormally high level of glucose. As a result the body switches it’s metabolism to breakdown fat to produce energy. This process produces acidic ketones as a byproduct and these build up in the blood causing a metabolic acidosis.

Question 56

Which of the following is the underlying problem in neurogenic diabetes insipidus?

A

Lack of Oxytocin

B

Lack of Prolactin

C

Overproduction of Vasopressin (Anti-diuretic Hormone)

D

Overproduction of Prolactin

E

Lack of Vasopressin (Anti-diuretic Hormone)

F

Overproduction of Oxytocin

Question 56 Explanation:

In Neurogenic Diabetes Insipidus the underlying problem involves the lack of Vasopressin production by the posterior pituitary. This can occur for a number of differ reasons

Question 57

Which of the following drugs does NICE recommend as first line therapy for overweight patients with type 2 diabetes?

What is the current treatment of choice for acromegaly in otherwise healthy patients?

A

Somatostatin analogues

B

Growth Hormone Receptor Antagonists

C

Watchful waiting

D

Trans-sphenoidal surgery

Question 58 Explanation:

At the moment most patients receive trans-sphenoidal surgery to remove the pituitary adenoma. This surgery cures acromegaly in 80% of patients with micro-adenomas & 40% of patients with macro-adenomas. Somatostatin analogues may be used immediately after diagnosis to reduce circulating levels of growth hormone whilst the patients is waiting for surgery. They also may be used long term in patients too unfit for surgery. Growth hormone receptor antagonists are a new therapy which is very targeted however at present it is only used on a limited basis (very expensive)

Studies of identical twins have shown only 30% concordance of developing type 1 diabetes. This suggests that the environment plays a very important role in the development of the disease. It has been suggested that a virus may trigger the disease in genetically susceptible individuals. This is thought to occur due to a virus having similar antigens to the pancreatic beta cells causing inappropriate immune activation. The Coxsackie virus is one organism which has been implicated as a trigger in some cases

Question 61

Which one of the following statements is true regarding the prevalence of acromegaly?

FSH stimulates sertoli cells to produce androgen binding globulin. This substance binds to testosterone and keeps it at high concentrations in the seminiferous tubules within the testes. This is important as high levels are required here for successful spermatogenesis.

Question 63

What of the following statements describes the pathology of hyperthyroidism as a result of toxic thyroid adenoma?

A

Inflammation of the thyroid gland due to infections or lymphocytic infiltration causes the stored thyroid hormones to all be released into the circulation leading to hyperthyroidism and usually thyrotoxicosis

A benign tumour of the thyroid gland which produces excessive amounts of thyroid hormones. These always arise from the follicular cells of the thyroid.

D

A malignant tumour of the thyroid gland which produces excessive amounts of thyroid hormones. These always arise from the follicular cells of the thyroid

Question 64

Which of the following are not causes of Neurogenic Diabetes Insipidus?

A

Pituitary adenoma

B

Mutatations in the vasopressin gene

C

Meningitis

D

Polycystic Kidney Disease

E

Sheehan's Syndrome

F

Trauma

G

Mutatations in the vasopressin (ADH) receptor gene

Question 64 Explanation:

Anything which affects the pituitary and it's production of vasopressin can ultimately cause Neurogenic Diabetes Insipidus. Mutations in the ADH receptor gene and Poly Cystic Kidneys are both causes of Nephrogenic Diabetes Insipidus

Question 65

Which of the following describes the best treatment option for iatrogenic cushing's syndrome?

A

Trans-sphenoidal surgery

B

Adrenalectomy

C

Gradual reduction of steroid dose & eventual withdrawal of drug

Question 65 Explanation:

Iatrogenic cushing's syndrome refers to cushing's syndrome occuring as a result of treatment with steroids. Therefore to treat this you need to gradually reduce the steroid dose and eventually stop it. It is very important not to suddenly stop steroid treatment as it can result in low serum cortisol levels (Addisonian Crisis) which is life threatening.

Question 66

What HBA1C level are patients recommended to aim for?

A

<7.5%

B

<12%

C

<15%

D

<10%

Question 67

What is the most common cause of Primary Polydipsia?

A

Defect in Vasopressin gene

B

Defect in Vasopressin (ADH) receptors

C

Psychological disorder

D

Overproduction of vasopressin (ADH)

E

Inability to produce vasopressin (ADH)

Question 67 Explanation:

Primary polydipsia is characterised by an individual consuming large volumes of fluids and as a result producing large volumes of dilute urine. The symptoms of primary polydipsia are therefore very similar to those of diabetes insipidus however a fluid deprivation test can help distinguish the diseases. Most often primary polydipsia is due to a psychological disorder.

Question 68

Which of the following is a fast acting insulin?

A

Novorapid

B

Glargine

Question 69

Which of the following is a long acting insulin

A

Glargine

B

Novorapid

Question 70

Which of the following causes of Hyperthyroidism is the most common?

A

Graves disease

B

Toxic Multi-nodular Goitre

C

Thyroiditis

D

Toxic Thyroid Adenoma

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